Establishment of the Health Sciences Centre

The events that are the subject of this Inquest occurred at the Children's Hospital during 1994. The Children's Hospital is part of the Health Sciences Centre (HSC), which is Manitoba's largest hospital. Through its affiliation with the University of Manitoba, the HSC is also Manitoba's primary medical teaching facility.

The HSC came into existence in February 1973, when The Health Sciences Centre Act (see SM 1998-99 c.41) was proclaimed, incorporating the Winnipeg General Hospital, the Women's Pavilion, the Children's Hospital of Winnipeg, the Manitoba Rehabilitation Hospital and the D. A. Stewart Centre (Respiratory Hospital) into one administrative and legal unit. The purpose of the merger was to produce global hospital planning, uniting these facilities under a single administration. A separate affiliation agreement was signed with the Manitoba Cancer Treatment and Research Foundation.

Until the amalgamation, the Children's Hospital had been a stand-alone institution, complete with its own corporate structure, board, budget and administration.

Under The Health Sciences Centre Act, the Women's Pavilion became known as the Women's Centre, the Winnipeg General Hospital became the General Centre and the Children's Hospital became the Children's Centre. The medical staff of the Children's Hospital was reorganized as the Department of Pediatrics and Child Health within the HSC, and the head of the Children's Hospital became the Head of Pediatrics and Child Health.

Despite the amalgamation, however, the Department of Pediatrics and Child Health and the Children's Centre are still referred to as the Children's Hospital (or simply the Children's). Those references will occur throughout this report, but it must be kept in mind that, during the period under discussion, the Children's Hospital was not a stand-alone institution.

This chapter outlines the overall structure of the HSC during 1994, with a particular focus on those units and departments associated directly or indirectly with pediatric cardiac surgery. Changes to the hospital's organizational structure that occurred during 1993-94 are discussed, along with their implications for the pediatric cardiac program. This chapter also highlights a number of committees and procedures that relate to the monitoring and maintenance of medical care.

In some sections a certain degree of ambiguity and confusion regarding lines of authority and responsibility will be apparent. During the course of hearings, witnesses gave differing accounts of what the responsibilities of various staff appointees were. Indeed, in some cases the appointees or staff people themselves expressed uncertainty about the full range of their own responsibilities and obligations. These matters will be dealt with in subsequent portions of the report. This chapter is meant to be an overall guide to the HSC's structures.

The 1994 HSC Reorganization

During 1993-94 the HSC undertook a major organizational review. Throughout this period, lines of authority were shifting. In June 1994, a major structural reorganization occurred that, among other things, saw the number of vice-presidents reduced from seven to four and a dramatic alteration in reporting lines. This reorganization was part of a larger reorganization that had been initiated by the Manitoba government in the early 1990s. At that time the government had hired the American Patient Management group (APM) to undertake a review of the operations of a number of Winnipeg health-care institutions. The review was headed by U.S. health-care consultant Connie Curran. One of the major thrusts of this review was to reduce health-care costs.

The restructuring involved the establishment of a number of 'patient improvement teams' (PIT teams) throughout the hospital. Each team was given a dollar figure goal and expected to find ways to reduce spending by that amount in the team's area. The Inquest was told that the team examining the in-patient budget (the amount spent treating patients in the hospital) was expected to find between $10 and $15 million worth of savings, approximately ten per cent of the total in-patient budget.

The review process began in the summer of 1993 and continued until the end of the year, with a staged implementation commencing in 1994. Many people who appeared before this Inquest indicated that the review process consumed a great deal of their time and energy during that period. The review naturally created serious anxieties for many hospital personnel. Their concerns were justified. The in-patient review that was expected to save $10 million looked almost solely at staff and service-delivery areas. In other words, the changes that came from its recommendations involved either altering people's jobs or eliminating positions.